Healthcare Provider Details

I. General information

NPI: 1124087895
Provider Name (Legal Business Name): BONNIE LYNN SELL REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 NEW YORK AVE
MANITOWOC WI
54220-3163
US

IV. Provider business mailing address

621 N 10TH ST
MANITOWOC WI
54220-3901
US

V. Phone/Fax

Practice location:
  • Phone: 920-683-9447
  • Fax:
Mailing address:
  • Phone: 920-686-9085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number128197
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: